Provider Demographics
NPI:1053421115
Name:PEARL, CRAIG W (PSY D)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:PEARL
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1106
Mailing Address - Country:US
Mailing Address - Phone:856-778-2100
Mailing Address - Fax:856-787-9588
Practice Address - Street 1:3804 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1106
Practice Address - Country:US
Practice Address - Phone:856-778-2100
Practice Address - Fax:856-787-9588
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00278800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4595009Medicaid
NJ4595009Medicaid
NJ667154Medicare PIN
NJ667154DSMMedicare PIN